The following is the current criteria listed in the most recent version of the Diagnostic and Statistical Manual of Mental Disorders for Intermittent Explosive Disorder. Most folks have not heard of impulse control disorders unless you know someone that has one of the five types or work in the medical field. Please do not read this and diagnose yourself or your loved ones. If you or someone you know needs treatment for mental health, please seek help in your area instead of trying to power through or be strong. It is okay and usually necessary to ask for help in a myriad of different areas.
DSM-5 Intermittent Explosive Disorder 312.34; (ICD-10-CD: F63.81)
Disorder Class: Disruptive, Impulse-Control, and Conduct Disorders
A. Recurrent behavioral outburst representing a failure to control aggressive impulses as manifested by either of the following:
Verbal aggression (e.g., temper tantrums, tirades, verbal arguments or fights) or physical aggression toward property, animals, or other individuals, occurring twice weekly, on average, for a period of 3 months. The physical aggression does not result in damage or destruction of property and does not result in physical injury to animals or other individuals.
Three behavioral outbursts involving damage or destruction of property and/or physical assault involving physical injury against animals or other individuals occurring within a 12-month period.
B. The magnitude of aggressiveness expressed during the recurrent outbursts is grossly out of proportion to the provocation or to any precipitating psychosocial stressors.
C. The recurrent aggressive outbursts are not premeditated (i.e., they are impulsive and/or anger-based) and are not committed to achieve some tangible objective (e.g., money, power, intimidation).
D. The recurrent aggressive outbursts cause either marked distress in the individual or impairment in occupational or interpersonal functioning, or are associated with financial or legal consequences.
E. Chronological age is at least 6 years (or equivalent developmental level).
F. The recurrent aggressive outbursts are not better explained by another mental disorder (e.g., major depressive disorder, bipolar disorder, disruptive mood dysregulation disorder, a psychotic disorder, antisocial personality disorder, borderline personality disorder) and are not attributable to another medical condition (e.g., head trauma, Alzheimer’s disease) or to the physiological effects of a substance (e.g., a drug of abuse, a medication). For children ages 6 to 18 years, aggressive behavior that occurs as part of an adjustment disorder should not be considered for this diagnosis.
The criteria I want to talk a bit more about is F. First I’ll remind everyone that anger is a universal human emotion. Having impulse control issues is found in a significant portion of the population but for a variety of reasons. The line that reads “not better explained by another mental disorder” then goes on to include several diagnoses that usually go hand in hand with adverse childhood experiences, also known as trauma. It is my opinion that many of these boxes we place people into may be a bit restricting healing, only in that people seem to take mental health diagnoses as part of their identity. The reality is that IED and many other mental health issues are completely treatable and manageable, but not if you isolate. Some of the major components of growth and development are our experiences and relationships. If the majority of your life has consisted of one crisis after another, it can be difficult to believe that increasing human contact would be the solution, especially if it was other humans doing the harm. The reality is that connections with other humans makes us feel less alone. With the adaptations required for the current pandemic, connecting has become difficult but not impossible. Some even say connecting from the comfort of their home makes it easier to maintain relationships.
Whether anger is considered a primary or secondary emotion, many people can agree that it is quite uncomfortable and would prefer to reduce the intensity. This can be accomplished through psychotherapy and/or Western/Eastern medication regimens. I find that folks who have significant success in regulating their emotions in the long term first develop their distress tolerance skills. Then, with that foundation one can build on their ability to respond rather than react to the information being absorbed through the five senses as well as the inner experience of the mind. Comment with your favorite anger management techniques.
